Nasopharyngeal Stenosis Workup

Updated: Nov 04, 2018
  • Author: Gauri Mankekar, MBBS, PhD, MS, DNB; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Imaging Studies

CT scanning and virtual endoscopy of the nasopharyngeal region can enable diagnosis and proper evaluation of the degree and extent of stenosis. This can, in turn, help to plan the surgical treatment. Axial CT scans can accurately define the nature and thickness of the atresia, the narrowing of the posterior nasal cavity, and the thickening of the vomer. A thorough preoperative assessment is needed to ensure the best surgical option for the individual lesion.

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Diagnostic Procedures

Preoperative rigid nasal endoscopic examination and/or flexible nasopharyngolaryngoscopy is essential to assess the thickness, nature and extent of the stenosis, the deformity of the posterolateral aspect of the nasal cavity, and to identify anatomical deformities at the level of the vomer and the posterior nasal cavity. Identifying concurrent upper aerodigestive tract stenosis, which may be present, is important.

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Histologic Findings

Histology of the resected scar tissue from the stenotic segment usually reveals respiratory epithelial lined stromal tissue with chronic inflammation, edema, and fibrosis.

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Staging

Krespi and Kacker proposed the following scale to grade the severity of nasopharyngeal stenosis: [12]

  • Nasopharyngeal stenosis (NPS) type I (mild)

  • Nasopharyngeal stenosis (NPS) type II (moderate)

  • Nasopharyngeal stenosis (NPS) type III (severe, wherein the entire palate fuses with the posterior and lateral palatal wall, leaving a residual nasopharynx opening with a diameter of less than 1 cm.)

Wang et al (2009) have divided acquired nasopharyngeal stenosis based on the duration between causative trauma/radiotherapy and diagnosis into the following 3 types: [13]

  • Type 1 - Diagnosed within 3 months of causative trauma/radiotherapy

  • Type 2 - Diagnosed between 3-6 months of causative trauma/radiotherapy

  • Type 3 - Diagnosed more than 6 months after trauma or radiotherapy

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